The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA

doi:10.1111/jdv.16924

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/24906

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/24906

Title:	The risk of anti-osteoporotic agent-induced severe cutaneous adverse drug reactions and their association with HLA
Authors:	Chen, CB;Chen, YE;Chu, MT;Wang, CW;Hui, RCY;Lu, CW;Hsiao, YP;Chu, CY;Chang, MM;Cheung, CMT;Cheng, CY;Wang, YW;Lin, YJ;Chang, CJ;Hung, SI;Chung, WH
Date:	2021
Issue Date:	2022-08-09T08:09:55Z (UTC)
Publisher:	WILEY
ISSN:	0926-9959
Abstract:	Background There is increasing use of anti-osteoporotic agents (AOA) worldwide for prevention or management of patients with osteoporosis. However, there have been reports of severe cutaneous adverse reactions (SCAR) induced by AOA. A recent study showed weak association between HLA and strontium ranelate (SR)-SCAR. Objective To characterize patients with AOA-SCAR and investigate the HLA association and utility of in vitro diagnostic methods. Methods We enrolled 16 cases with AOA-cutaneous adverse drug reactions (cADR), including SCAR (n = 10: 8 with Stevens-Johnson syndrome [SJS] and 2 with drug rash with eosinophilia and systemic symptoms [DRESS]) and maculopapular exanthema (MPE) (n = 6) from Taiwan and Hong Kong. We analysed the clinical characteristics, outcomes, HLA alleles and in vitro testing of AOA-SCAR, and tolerability to alternative drugs. We further performed literature review and meta-analysis on the HLA association of AOA-SCAR. Results Our data showed strontium ranelate is the most common causality of AOA-SCAR in Asian populations. There was no cross-hypersensitivity of SR-SCAR with other AOA. HLA genotyping showed that SR-SJS was most significantly associated with HLA-A33:03 (Pc = 5.17 x 10(-3), OR: 25.97, 95% CI: 3.08-219.33). Meta-analysis showed that HLA-A33:03 was associated with SR-SJS (P = 5.01 x 10(-5); sensitivity: 85.7%) in Asians. The sensitivity of lymphocyte activation test (LAT) for identifying the culprit drug of SR-SJS was 83.3%. Conclusions Strontium ranelate is identified as the most notorious AOA associated with SCAR. The HLA-A*33:03 genetic allele and LAT testing may add benefits to the diagnosis of SR-SCAR in patients whose reaction developed while taking multiple drugs.
URI:	http://dx.doi.org/10.1111/jdv.16924 https://www.webofscience.com/wos/woscc/full-record/WOS:000601621400001 https://ir.csmu.edu.tw:8080/handle/310902500/24906
Relation:	JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY ,2021 ,v35 ,issue 3 ,p712-720
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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